MEDICARE: MADISON HANNAH SMITH RD, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86106643

General Provider Information

NPI Number	:	1891263968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON HANNAH SMITH RD, LD

Provider Business Mailing Address
First Line	:	2621 W MAINE AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-5140
Country	:	US
Telephone Number	:	714-262-0645
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 W BOISE CIR FL 3
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-4900
Country	:	US
Telephone Number	:	918-994-8300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2018
Last Update Date	:	11/07/2018

Similar Medicare Providers

1073439972 — BRETT COLE TAYLOR
Practice Location Address:

1000 W BOISE CIR
BROKEN ARROW, OK
74012-4900

Practice Phone: 918-994-8000
Practice Fax:

1427132182 — MAYS DRUG STORES IN
Practice Location Address:

4900 W KENOSHA ST
BROKEN ARROW, OK
74012-8517

Practice Phone: 918-461-9968
Practice Fax: 918-416-9049

1003047853 — GARRET CARL OLSON D.O.
Practice Location Address:

1000 W BOISE CIR , ST JOHN OWASSO - EMERGENCY DEPT
BROKEN ARROW, OK
74012-4900

Practice Phone: 918-994-8000
Practice Fax: 918-994-8497

1497988596 — ST. JOHN BROKEN ARROW, INC
Practice Location Address:

1000 W BOISE CIR
BROKEN ARROW, OK
74012-4900

Practice Phone: 918-994-8100
Practice Fax: 918-994-8199

1205588928 — POST ACUTE PHYSICIANS, LLC
Practice Location Address:

1000 W BOISE CIR FL 3
BROKEN ARROW, OK
74012-4900

Practice Phone: 918-994-8000
Practice Fax:

1609583533 — KYLE JAMES BATES PHARM.D.
Practice Location Address:

1000 W BOISE CIR
BROKEN ARROW, OK
74012-4900

Practice Phone: 918-994-8149
Practice Fax:

Directions to “ MADISON HANNAH SMITH RD, LD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.